Provider Demographics
NPI:1093807406
Name:FLORISSANT CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:FLORISSANT CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:ERNST
Authorized Official - Last Name:KOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-837-4210
Mailing Address - Street 1:1160 S NEW FLORISSANT RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-7702
Mailing Address - Country:US
Mailing Address - Phone:314-837-4210
Mailing Address - Fax:314-837-0718
Practice Address - Street 1:1160 S NEW FLORISSANT RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-7702
Practice Address - Country:US
Practice Address - Phone:314-837-4210
Practice Address - Fax:314-837-0718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004414111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty